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What time in the menstrual cycle do most symptoms of premenstrual syndrome (PMS) and premenstrual dysphoria disorder (PMDD) occur?

A. Luteal phase

B. Follicular phase

C. Ovulation

D. Menstruation

B. Symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) occur cyclically starting 5-7 days prior to menstruation, which would be during the follicular phase.

A. The luteal phase starts with menstruation. PMS/PMDD symptoms do not occur during this time.

C. Ovulation occurs immediately prior to the follicular phase. PMS/PMDD symptoms do not occur during this time.

D. Symptoms of PMS/PMDD usually disappear shortly after the onset of menstruation.

While the pathophysiology of PMS and PMDD is not fully understood, which biologic theory has been investigated?

A. Increased estrogen production resulting in reduced serotonergic activity

B. Progesterone concentrations are high in relation to estrogen concentrations

C. Increase in GABA activity during the late luteal phase

D. Calcium dysregulation due to estrogen concentration fluctuations

D. Calcium metabolism is regulated by estrogen, which fluctuates during the menstrual cycle. Hypocalcemia can manifest as depression and anxiety. Calcium supplementation can relieve somatic and mood symptoms and premenstrual syndrome (PMS).

A. Estrogen production, along with progesterone and testosterone, have been shown to increase serotonergic activity by increasing the number of serotonergic receptors, transport and uptake.

B. Estrogen concentrations are high in relation to progesterone resulting in a hormone ratio imbalance that can lead to premenstrual dysphoric disorder (PMDD).

C. Decreases in GABA activity has been associated with anxiety and depression. Low GABA concentrations and low GABA receptor sensitivity are present during the late luteal phase in women with PMS and PMDD.

E.G. is a 19-year-old woman complaining of crying spells occurring 6 days prior to menses consistently for the last 6 months. She has also experienced significant insomnia during this time that has resulted in her missing multiple classes throughout the fall semester. Her symptoms resolve within 24 hours of starting menses. What criteria does E.G. meet for PMDD according the DSM-V-TR?

A. Daily function is impaired since she is missing classes

B. Symptoms occur during the follicular phase

C. Symptoms have occurred for at least 4 consecutive months

D. Changes in ...

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